March 21, 2022 Network in the Know

Code auditing changes effective March 23, 2022

For claims processed on or after March 23, 2022, you may notice differences related to changes in code pairs in CCI, which includes modifier override changes; daily frequency limits; incidental, mutually exclusive and unbundled code edits; assistant surgeon eligibility; modifier to procedure compatibility; evaluation of incomplete diagnosis; global surgery pre-operative and post-operative periods as defined by CMS; and other standard coding code edits. Here is a high level summary of some of the changes. This is not an all-inclusive list.

  • Numerous updates due to the release of January 1, 2022 CPT® and HCPCS codes additions, changes and deletions.

Professional Claims:

New

Denied CodeDescriptionPaid CodeDescription
93621Electrophysiology93653EP & Ablate Supravent Arrhyt
93662Intracardiac ECG (ICE)93656TX Atrial Fib Pulm Veinisol
93613Electroyphys Map 3D Add-On93653, 93656EP & Ablate Supravent Arrhyt, TX Atrial Fib Pulm Veinisol
Source: AMA

New – this will be retrospective to 03/09/2020 per CMS guidance

Denied CodeDescriptionPaid CodeDescription
G2023Specimen Collect COVID-19Numerous E/M CodesNumerous Evaluation and Management
G2024Specimen Collect COVID-19Numerous E/M CodesNumerous Evaluation and Management
Source: CMS

  • CCI v28.0 and OCE_CCI v28.0 additions, deletions and changes including when modifier overrides are allowable per CMS guidelines.

New

Denied CodeDescriptionPaid CodeDescription
NumerousEvaluation and Management Procedures; and Preventive Evaluation and Management Procedures, Screening Procedures and Counseling ProceduresSeveralCovid-19 vaccine administration procedures.
Source: CCI v28.0

Facility Claims

New

Denied CodeDescriptionPaid CodeDescription
NumerousEvaluation and Management Procedures; and Preventive Evaluation and Management Procedures, Screening Procedures and Counseling ProceduresSeveralCovid-19 vaccine administration procedures.
87635Sars-Cov-2 COVID-19 Amp Prb87428 87636 87637Sarscov & Inf Vir A&B AG IA, Sarscov2 & Inf A&B Amp Prb , Sarscov2&Inf A&B&Rsv Amp Prb
93613Electroyphys Map 3D Add-On93653, 93656EP & Ablate Supravent Arrhyt, TX Atrial Fib Pulm Veinisol
93621Electrophysiology93653 93654EP & Ablate Supravent Arrhyt , EP & Ablate Ventric Tachy
93662Intracardiac ECG (ICE)93656TX Atrial Fib Pulm Veinisol
OCE_CCI v28.0

For reference to the claims-processing rules currently in place and significant customization, please refer to the Code Auditing Rules and Customization, 1550/20.000162 payment policy.

As a reminder, Clear Claim Connection is available on the CDPHP Secure Provider Portal. This claims editing tool allows providers to enter a specific coding scenario and view the editing results in place on the date of the inquiry. If a denial is issued for the coding scenario, the rationale for the denial is provided. The results of a coding inquiry may differ from the results of an actual claim payment as a claim may be affected by other factors, such as member eligibility or other claim processing and/or pricing logic.

For more information, please call CDPHP Provider Services at (518) 641-3500 or 1-800-926-7526.

Karen Faxon
About the Author

Karen Faxon is a registered nurse and certified coder who joined the CDPHP® workforce in 1996. Since then, Karen has worn many hats at CDPHP. Currently, she is a Senior Clinical Configuration analysis ensuring integrity of clinical codes and code auditing software. On weekends, you can often find her gardening or walking her two dogs, Tilly and Jazzy.

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